Pneumonia, Neonatal (Group B Streptococcus)

Clinical Presentation:
Associated with premature rupture of the membranes (PROM) during
labor. The disease may have an early onset with septicemia and
fulminant progression to severe respiratory distress, shock and
respiratory failure within 24 hours; or a late onset 1 to 12 weeks
after birth with this more insidious onset frequently associated with
meningitis. Neonatal pneumonia can closely mimic hyaline membrane
disease clinically, and is the most frequent cause of septicemia in
neonate.

Etiology/Pathophysiology:
There are three ways for the baby to acquire a neonatal pneumonia.
First is infection acquired prior to birth by an ascending route or
transplacental route. Classically this is Group B Streptococcus in
the mother's vagina which passes to the infant during birth,
particularly in cases with prolonged rupture of membranes and
prolonged labor. Other normal inhabitants of the birth canal - staph,
strep, diphtheroids, anaerobes, E. coli and Listeria - are other
pathogens that may cause neonatal pneumonia. Second is infection
acquired by aspiration during delivery, with the pathogens remaining
the same. Third is via infection acquired after birth.

Pathology:
There is a less uniform distribution of hyaline membranes in
collapsed alveoli than is seen in hyaline membrane disease. There are
cocci in the alveolar membrane and in the interstitial inflammatory
exudate.

Imaging Findings:
Ascending infection may resemble hyaline membrane disease very
closely, especially in smaller infants. Most commonly seen are
extensive granular confluent infiltrates whose distribution is often
less uniform than that of hyaline membrane disease.
There is less atelectasis than in hyaline
membrane disease. May have pleural fluid and a normal lung volume,
further distinguishing factors from hyaline membrane disease.
Infection acquired perinatally often has a confluent miliary or
nodular pattern that looks like meconium aspiration or transient
tachypnea of the newborn while postnatally acquired infection often
has a patchy more asymmetric pattern that looks like infection in
older children.

DDX:

Hyaline Membrane Disease - usually has a uniform distribution
of pulmonary opacities, never has pleural effusions, has a
decreased lung volume.

Meconium Aspiration - usually has nodular non homogeneous
densities, may have pleural effusions, usually has an increased
lung volume.

Transient Tachypnea of the Newborn - usually has non
homogeneous densities, may have pleural fluid.

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